| Entity Name: | AFFINITY TRANSPORTATION SERVICE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Oct 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 04 Jan 2021 (4 years ago) |
| Document Number: | L20000316406 |
| FEI/EIN Number | 85-3334379 |
| Address: | 12236 TAVARES RIDGE LANE, TAVARES, FL, 32778, US |
| Mail Address: | 12236 Tavares Ridge Lane, TAVARES, FL, 32778, US |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154922946 | 2020-11-06 | 2020-11-06 | 12236 TAVARES RIDGE LN, TAVARES, FL, 327784460, US | 12236 TAVARES RIDGE LN, TAVARES, FL, 327784460, US | |||||||||||||||||||
|
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| Phone | +1 352-630-0297 |
Authorized person
| Name | GREGORY WILLIAMS |
| Role | OWNER |
| Phone | 3526300297 |
Taxonomy
| Taxonomy Code | 343900000X - Non-emergency Medical Transport (VAN) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108279600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILLIAMS GREGORY T | Agent | 12236 TAVARES RIDGE LANE, TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| WILLIAMS GREGORY T | President | 12236 TAVARES RIDGE LANE, TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| Casteel Maxine R | Vice President | 12236 Tavares Ridge Lane, tavares, FL, 32778 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-06-28 | 12236 TAVARES RIDGE LANE, TAVARES, FL 32778 | No data |
| LC AMENDMENT | 2021-01-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-04-28 |
| AMENDED ANNUAL REPORT | 2022-06-28 |
| AMENDED ANNUAL REPORT | 2022-06-26 |
| AMENDED ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2022-02-01 |
| AMENDED ANNUAL REPORT | 2021-10-28 |
| AMENDED ANNUAL REPORT | 2021-08-12 |
| ANNUAL REPORT | 2021-04-30 |
| LC Amendment | 2021-01-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
